Provider Demographics
NPI:1053852830
Name:BURTON DENTAL CENTER
Entity type:Organization
Organization Name:BURTON DENTAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-744-0433
Mailing Address - Street 1:1140 S BELSAY RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1909
Mailing Address - Country:US
Mailing Address - Phone:810-744-0433
Mailing Address - Fax:
Practice Address - Street 1:1140 S BELSAY RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1909
Practice Address - Country:US
Practice Address - Phone:810-744-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI143911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty